ORDER
Per Sh. Rakesh Kapoor, President
The complainant had obtained a mediclaim policy from the OP and during the subsistence of the same had lodged a claim in respect of his treatment for a sum of Rs. 28,995/-.
The insurance company has repudiated the claim solely on the ground that the claim documents which ought to have been submitted within 30 days , were submitted after three months of the date of discharge.
We have heard arguments advanced on both sides and have perused
the record.
In view of the above instructions of IRDA, we hold that the repudiation of the claim filed by the complainant on the ground of delay was not justified. We hold the OP deficient in rendering services to the complainant and direct it as under:-
- Pay to the complainant a sum of Rs. 28,995/- along with interest @10% p.a. from the date of institution of this complaint i.e. 27.9.2008 till payment.
- Pay to the complainant a sum of Rs. 5,000/- as compensation/ cost of litigation.
The above amount shall be paid by the OP to the complainant within 30 days from the date of this order failing which OP shall be liable to pay interest on the entire awarded amount @ 10% per annum from the date of this order till the date of payment. If OP fails to comply with the order within 30 days, the complainant may approach this Forum u/s 27 of the Consumer Protection Act, 1986.
Copy of the order be made available to parties free of cost as per law.
File be consigned to R/R.
Announced in open sitting of the Forum on_____________
